The Arizona Republic
How Guadalupe slashed its COVID-19 case rate
Veronica Tavena-Perez thought she would be staying home to care for her 3year-old son after retiring in November from her job as a social worker for the Pascua Yaqui Tribe.
She was at home watching a movie with her son when the phone rang one day in late May. Guadalupe Mayor Valerie Molina was on the line, and asked to meet at Town Hall the following day.
Guadalupe, a town of about 6,600 residents tucked along Interstate 10 between Tempe and Chandler, was in trouble.
COVID-19 cases were spiking in the
community that is mostly Hispanic, Native American or a combination of the two. Multiple generations of families often live together and many residents are service workers, deemed essential in the pandemic.
Studies are showing the new coronavirus has disproportionately affected Native American and Hispanic communities.
The town needed a trusted voice to lead efforts to reduce the virus’s spread, the mayor told her.
Tavena-Perez, a Guadalupe native, accepted.
“I have worked in the community for the past 40 years,” she said. “I had to help.”
Around the time she returned to work in June, the town had 87 confirmed cases. The number of cases reached 131 by June 16 before the COVID-19 Response Team she leads saw things begin to improve.
Partners on the response team include Maricopa County, the Pascua Yaqui Tribe and Arizona State University.
They’ve brought in testing. They’ve delivered food and necessities to people who are recovering from COVID-19 at home. They’ve educated residents on the importance of wearing masks and social distancing.
And their efforts seem to be working. Rumors of the first COVID-19 case in Guadalupe spread through the town in March.
Residents called the mayor for information about the case — who was it and where had the person contracted the virus?
“Do I need to worry about my grandmother?”
“My mom lives there by herself and has underlying conditions,” another caller worried.
Molina had no information to give. It wasn’t even a confirmed case. “Just the possibility of one sent the whole community into panic,” she said.
The calls continued as word of more cases grew. Residents thought town officials were keeping them in the dark.
“In actuality, we didn’t have the information to share,” Molina said.
Other than residents who self-reported, town officials could only turn to state health data that was of little use. The Arizona Department of Health Services reports cases by ZIP code. Guadalupe falls into a larger Tempe ZIP code with nearly 46,000 people.
Despite a lack of data, town officials had a hunch they were experiencing a spike in cases. The calls from residents reporting symptoms and positive test results had increased by mid-May.
Then ASU researchers reached out to town officials with a warning: Wastewater samples taken from the sewage system showed elevated levels of the virus. ASU had been monitoring for traces of COVID-19 in Tempe and Guadalupe’s wastewater since March. The high concentration meant there likely was community spread.
Armed with the wastewater study, Molina made the case to Maricopa County officials for more localized data.
County health officials began combing through paperwork on positive COVID-19 test results to track Guadalupe addresses. They have provided town officials with weekly updates on case numbers and hospitalizations since June 1.
It was “eye opening,” Molina said. “We had so many people in our backyard this whole time dealing with this on their own and we didn’t know.”
Molina spent the next couple of weeks calling and emailing organizations and regional and state leaders in search of help. She looked to other small towns, such as Tolleson on the other side of Phoenix, to share resources and contacts.
With an annual budget of about $12 million and17 full-time employees, Guadalupe’s resources were sparse.
It was around this time that Molina called Tavena-Perez.
Tavena-Perez and Graciela Holguin, a hospice worker with family ties in Guadalupe, joined together as promotoras.
A promotora is a uniquely Hispanic program that serves as a bridge between public health officials and residents. A promotora typically is a lay person with deep ties in a community to establish trust. Historically in Latin America and the U.S., promotoras have addressed chronic diseases and other health issues.
While other groups have tried to come in to assist Guadalupe through the years, residents can sometimes be wary of strangers, Molina said.
“It’s not that they don’t want the help, it’s that they don’t understand who you are and what the purpose behind it is,” Molina said. “But if we bring someone from our community that people know, have grown up with, they are going to be more likely to open their door than they would to others.”
Molina grew up in Guadalupe and remembers the effectiveness of promotoras preaching children’s health and teen pregnancy prevention. The program was run by a nonprofit agency that had since closed, but Molina saw a role for promotoras in the pandemic.
The town hired Tavena-Perez, who is Yaqui, and Holguin on a part-time, temporary basis.
On a recent Thursday, Tavena-Perez reached over the fence of a resident’s home and placed a box of food and other items on a chair set below. Inside, the family was recovering from COVID-19.
Tavena-Perez and Holguin have been delivering such boxes to families impacted by the virus since June.
The boxes include fish, chicken breasts, eggs, rice and beans and the occasional produce and fruit. The town sometimes provides laundry detergent, disinfecting wipes and other items requested by families.
The promotoras also drop off masks and hand sanitizer.
The visits are typically zero contact. They ask families to place a chair or bench outside where they leave the boxes.
Sometimes residents come out to talk with them from their doorstep. Other times the promotoras follow up with a call to check in.
They offer information on healthy hygiene practices. They may discuss how to disinfect the home, how to protect oneself when leaving the house or offer details about financial assistance that’s available.
The goal is to curb the virus’s spread. The Guadalupe Fire Department and the Pascua Yaqui Tribe also have distributed masks or food and educational materials.
Molina sees the promotora program as part of the reason behind the town’s improving numbers.
Bringing testing into the community was another key component.
The town keeps residents up to date on the pandemic through online posts.
Early in the pandemic, Molina and
Vice Mayor Ricardo Vital, who are cousins, shared a video of themselves getting tested for COVID-19 to encourage residents to do the same.
Initially, there wasn’t much interest. Many residents were uncomfortable traveling just two miles away to a testing site in Tempe, Molina said.
The mayor knew she had to bring testing to them, so she networked. She reached out to U.S. Rep. Ruben Gallego’s office, which connected her with Valle Del Sol, a community health agency that primarily serves the Latino community.
Valle Del Sol sponsored a free, twoday testing blitz in Guadalupe in June and about 400 people got tested.
The Pascua Yaqui Tribe employs about100 people in its Guadalupe office. They tested tribal employees and many tribal members in the town.
The tribe and several partners now are conducting COVID-19 testing for seniors and people with disabilities in their homes, said Vital, who works for the tribe.
The tribe is working on an agreement with the county to share the tribe’s testing and case data to provide a more accurate picture of the virus’s impact, he said.
About half of Guadalupe residents are Pascua Yaqui Tribal members and the other half identify as Hispanic of Mexican descent. Many residents, like Molina, identify as both.
Guadalupe was founded by Yaqui Indians who fled persecution in Mexico, and settled in the Salt River Valley in the early 1900s. The Pascua Yaqui Tribe maintains offices in Guadalupe, although its reservation is in the Tucson area.
Town and tribal officials estimate that between 1,000 and 1,500 people have been tested for COVID-19 since June.
The goal is to test everyone at least once, Vital said.
Data has shown that minorities are at increased risk of getting sick or dying from COVID-19 because they are more likely to have underlying health conditions, live in crowded conditions, work in lower paying essential jobs and have less access to health care.
Limited internet and telephone access, language barriers and a distrust of institutions all can make it harder to access trusted information, according to Johns Hopkins University.
In Arizona, Native Americans have been among the hardest hit population groups. Native Americans make up just 3.9% of the state’s population, but they make up 6% of COVID-19 cases and 11% of deaths, state health data shows.
The Navajo Nation had the highest infection rate in the country in May.
When Guadalupe officials got their first report from the county on June 1, it showed the town’s residents were testing positive at 5.6 times the county rate. Guadalupe had one of the highest infection rates in the county.
Will Humble, former head of the state health department, said many of the same factors that contributed to the Navajo Nation becoming a hot spot contributed to Guadalupe’s rise in cases.
The less than one-square mile community is dotted with single story homes, many built before the 1980s and smaller than 1,200 square feet. Multiple generations of families often live together.
Many Guadalupe residents also have preexisting health conditions, such as diabetes and hypertension, which makes them more susceptible to the virus, Vital said.
Guadalupe has seen 403 reported COVID-19 cases as of Sept. 16, but the numbers are improving.